A talented and irreplaceable staff member is accepting bribes in order · Medical

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J A talented and irreplaceable staff member is accepting bribes in order to prioritise patients. How might this be addressed?

Specific Topic(s):

• Probity as a professional standard.

• Is this behavior an indicator of something else?

Key references:

‘Ethical principles of health care in times of armed conflict and other emergencies’ –

1. Ethical principles of health care do not change in times of armed conflict and other emergencies and are the same as the ethical principles of health care in times of peace.

4. Privileges and facilities afforded to health-care personnel in times of armed conflict and other emergencies are never to be used for purposes other than for health-care needs.

Geneva Conventions:

Not relevant

Customary IHL:

Not relevant

Ethical principles:

WMA INTERNATIONAL CODE OF MEDICAL ETHICS - https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/

A PHYSICIAN SHALL not allow his/her judgment to be influenced by personal profit or unfair discrimination.

A PHYSICIAN SHALL deal honestly with patients and colleagues, and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception.

A PHYSICIAN SHALL not receive any financial benefits or other incentives solely for referring patients or prescribing specific products.

Discussion:

Review of the question: superficially this is an easy scenario, but we will unpack it further through the discussion.

Interpretation of the principles/policy from the references: it is clear that it would be ethically unacceptable to accept bribes to prioritise patients. It is highly likely that this behaviour would be subject to military law and criminal law. In crisis situations, there is considerable scope for unethical behaviour especially if individuals (e.g. healthcare workers) have control of a commodity in high demand.

Framework for answering the scenario/question:

• What is the evidence for this allegation?

• How might the allegation be proven?

• How should any investigation into the allegation be undertaken and who should do it?

• Who needs to know about the investigation? – chain of command, police, professional regulatory bodies, etc.

• What needs to be done regarding the practice of the staff member whilst the allegations are being investigated? – should they be suspended, should any other aspects of their practice be investigated?

• How should the staff member be supported whilst they are under investigation?

Further discussion points

• This is a relatively easy question if the staff member is a formal employee/member of your military unit who could be expected to know that their behavior was wrong...but:

o What if they are senior to you?

o What if they cannot be suspended/replaced and you need their clinical skills?

o What if you have no jurisdiction (for instance if they are the head of another national contingent)?

o What if strong rumours cannot be substantiated by evidence?

o What if they are one of your key interpreters with strong local connections?

o What if there was no evidence of bribes, but you were suspicious of their referral patterns?

o What if they admit the allegations but claim stress and mental health illness in mitigation?

o What if they are a very junior employee and claim financial hardship?

o What if they claim that this was ‘authorised private practice’?

• What is the difference between professional ethics and organisational ‘codes of conduct’? Compare the ICRC Code of Conduct or the MSF Behavioral Standards with a military code of conduct that might apply to your role (e.g. British Army Values and Standards). How might you ensure that your personnel were aware of their behavioral responsibilities?

• Is anyone truly irreplaceable? Is it possible for a clinically competent individual to do more harm than good but their personal behaviour?

Author: Professor Martin Bricknell